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Death Knell for Syphilis?

Gov't report says end is near for ancient sexual disease

WEDNESDAY, Nov. 28, 2001 (HealthDayNews) -- Syphilis, the killer disease that has spread devastation through the centuries, is a step closer to becoming history itself.

The number of cases in the United States fell to the lowest level ever in 2000, according to figures released today, and federal officials think they're on track toward vanquishing the disease forever.

"Elimination of syphilis is a feasible goal," said Dr. Ronald Valdiserri, deputy director of the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention.

All of the 5,979 reported syphilis cases last year were in only 20 percent of the counties in the country, the CDC figures show.

There are some hitches, however. Although syphilis rates are dipping among heterosexuals, they appear to be rising among gay men. And syphilis continues to disproportionately affect poor blacks, who are 21 times more likely to get it than whites in general.

Syphilis throughout history has had no respect for wealth or rank, killing both kings and commoners. Gangster Al Capone and writer Guy de Maupassant died of it; composer Franz Schubert contracted it. Left untreated, it can cause heart problems, brain disorders, blindness and eventually death. Antibiotics can cure it, though, if it's caught early.

From a high of 106,000 cases in 1947, just after World War II, syphilis infection rates declined steadily in the United States. The number of cases, however, spiked back up to 39,000 in 1988, an increase attributed to a crack cocaine epidemic that spawned an increase in the number of people selling sex for drugs.

Last year's total number of cases, 5,979 of primary and secondary syphilis, represents a decrease of almost 10 percent from 1999 and a 30 percent drop from 1997. The number of babies infected with syphilis by their pregnant mothers has also decreased.

Federal officials attributed the decrease to prevention programs instituted in several communities and to better monitoring of outbreaks. "This comprehensive approach has begun to pay off," Valdiserri said.

He added that Canada and England have already shown that syphilis can be virtually eliminated.

According to the CDC, the highest number of cases -- more than 100 each -- were in the city of Baltimore and in the counties that are home to these cities: Chicago, Indianapolis, Detroit, Memphis, Atlanta, Nashville, Phoenix, Los Angeles, Miami and Dallas. By contrast, 80 percent of the nation's 3,135 counties were free of syphilis in 2000.

The goal of the federal syphilis elimination program, introduced in 1998, is to reduce the number of syphilis cases to lower than 1,000 by 2005.

Syphilis is transmitted through both homosexual and heterosexual sex. In 2000, outbreaks of the disease hit gay male communities in several cities, including Seattle, Los Angeles, Miami Beach, Chicago and New York City.

Valdiserri acknowledged that the CDC has no idea how many of the total cases from 2000 are gay-related because some monitoring agencies don't keep track of sexual orientation. "That is clearly a problem. It's clearly a deficit," Valdiserri said.

Although the statistics are lacking, the number of gay victims does appear to be "relatively small," said Dr. George Counts, director of the CDC's syphilis elimination program. But as many as 70 percent of those victims may also be infected with HIV, the virus that causes AIDS, he added

"That's a very troubling element and heightens our activities of focusing on [that group]," Counts said.

Syphilis is easily treatable with penicillin. But the disease appears to raise the likelihood that sufferers will be susceptible to AIDS infection.

"We do need to do a better job of collecting information about sexual practices in terms of the transmission of syphilis," Valdiserri said. "For many of our STDs, this is not routinely done."

Valdiserri said the CDC will focus more on prevention of syphilis in the gay community.

So far, the intense federal efforts to combat bioterrorism haven't affected efforts to combat STDs, Valdiserri said. "Syphilis hasn't gone away because of anthrax, nor has tuberculosis or HIV or the other sexually transmitted diseases we deal with."

What To Do

To learn more about syphilis and its symptoms, read this fact sheet compiled by the American Social Health Association.

You can also learn about syphilis from this fact sheet prepared by the National Institute of Allergy and Infectious Diseases.

SOURCES: Teleconference from the "Syphilis Elimination Through Community Partnerships: A Public Health Formula for Success" conference in Dallas with Ronald O. Valdiserri, M.D., MPH, deputy director, Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention, Atlanta; and George Counts, M.D., director of CDC syphilis elimination program, Atlanta
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